title: Structural abnormalities in patients with insular/peri-insular epilepsy: spectrum, frequency, and pharmacoresistance.
abstract: Between 2002 and 2010, a total of 48 patients were seen at our epilepsy clinic with insular/peri-insular cortex epilepsy. Review of their MR imaging scans revealed a neoplastic lesion in 27% of patients, a malformation of cortical development in 21%, a vascular malformation in 19%, and atrophy/gliosis from an acquired insult in 17%. MR imaging results were normal in 4 patients. Other miscellaneous findings included a case of Rasmussen encephalitis, a nonspecific insular millimetric T2 signal abnormality, a neuroepithelial cyst, and hippocampal sclerosis without MR imaging evidence of dual insular pathologic features (despite depth electrode-proven insular seizures). Refractoriness to antiepileptic drug treatment was present in 56% of patients: 100% for patients with malformations of cortical development (1.0; 95% CI, 0.72-1.0), 50.0% (0.5; 95% CI, 0.21-0.78) in the presence of atrophy/gliosis from acquired insults, 39% (0.39; 95% CI, 0.14-0.68) for neoplastic lesions, and 22.2% (0.22; 95% CI, 0.06-0.55) for vascular malformations.
authors.affiliation: Radiology Department.
authors.forename: M-C
authors.initials: MC
authors.lastname: Chevrier
authors.forename: C
authors.initials: C
authors.lastname: Bard
authors.forename: F
authors.initials: F
authors.lastname: Guilbert
authors.forename: D K
authors.initials: DK
authors.lastname: Nguyen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use*; D002540:Cerebral Cortex / Q000187:drug effects / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D004351:Drug Resistance; D004827:Epilepsy / Q000188:drug therapy* / Q000473:pathology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000927:Anticonvulsants